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Biomedical subjects

M Fleming

Publications and source records attributed to M Fleming.

At least 19 recordsLinked to original sources
PubMed2006

Psychological aspects of pre-symptomatic testing for Machado-Joseph disease and familial amyloid polyneuropathy type I.

Machado-Joseph disease [MJD, also spinocerebellar ataxia type 3 (SCA3)] and familial amyloid polyneuropathy type I (FAP-I or ATTR V30M) are neurodegenerative disorders, inherited in an autosomal dominant fashion, which have a high prevalence in Portugal, probably due to a founder effect. MJD and FAP-I are late-onset diseases, with symptoms emerging usually during adulthood. CGPP, which is the national reference centre for these disorders, has a genetic lab that offers diagnostic, pre-symptomatic and prenatal testing and an outpatient clinic to counsel and follow relatives at risk for hereditary ataxias, FAP-I and Huntington disease (HD). The present work is a review of our 10-year experience with psychological counselling of individuals at risk for MJD and FAP-I. Persons at risk for FAP-I may show a better response to pre-symptomatic testing than those who are at risk for MJD and HD because of the availability of liver transplantation, which may improve their health and life expectancy. Psychological well-being and specific distress of MJD and FAP-I test applicants, before undergoing genetic testing (baseline level) and 3 to 6 months after disclosure of test results, have shown a low level of change, both in identified carriers and non-carriers. A major goal of psychological characterization of at-risk individuals for MJD and FAP-I is to determine the factors that influence the uptake of genetic testing.

Amyloid Neuropathies, Familial↗
PubMed2006

Analysis of canine and feline blood samples using the Kuadro in-house wet-reagent chemistry analyser.

OBJECTIVES: Kuadro is a new wet-reagent biochemistry analyser that is available for in-house use. The aim of this study was to compare the results produced by this analyser with those obtained by a wet-reagent analyser (KoneLab 30i) that served as the reference instrument. METHODS: Blood samples from 80 clinical cases (40 dogs and 40 cats) were analysed for urea, creatinine, total proteins, albumin, glucose, cholesterol, alanine aminotransferase, alkaline phosphatase, total bilirubin, amylase, total calcium, and phosphate using both the reference and Kuadro instruments. RESULTS: Kuadro performed very well on canine and feline samples, showing clinically acceptable correlations (r value) (canine/feline) for urea (0.99/0.97), creatinine (0.99/0.98), total proteins (0.95/0.97), albumin (0.98/0.90), glucose (0.99/0.99), cholesterol (0.99/0.99), alanine aminotransferase (1.00/0.99), alkaline phosphatase (0.96/0.99), total bilirubin (1.00/1.00), amylase (0.98/0.96), and phosphate (0.91/0.92). The correlation for total calcium measurements was clinically unacceptable (0.78/0.83). CLINICAL SIGNIFICANCE: Urea, creatinine, albumin, glucose, cholesterol, alanine aminotransferase, and phosphate Kuadro values can be used interchangeably with those generated by the reference analyser. Alkaline phosphatase, amylase, and total proteins Kuadro values cannot be used interchangeably, as Kuadro overestimated alkaline phosphatase and amylase and underestimated total protein measurements. Kuadro significantly underestimated total calcium concentrations due to the shorter incubation time used by the Kuadro analyser compared with the incubation time used in the reference analyser assay system.

Animals↗
PubMed2005

The cost of medical care for patients with diabetes, hypertension and both conditions: does alcohol use play a role?

OBJECTIVE: To estimate and compare the medical costs of individuals with diabetes and/or hypertension relative to a matched sample of individuals with neither condition, and determine if these costs are significantly influenced by alcohol use. RESEARCH DESIGN AND METHODS: Data were obtained from a sample of 799 patients from eight primary care clinics in south-central Wisconsin between 2001 and 2002. Medical care costs were calculated within four categories [hospital and emergency room (ER) costs, clinic costs, medication costs and total cost] for three chronic disease samples [diabetes only (n = 89), hypertension only (n = 299), and both diabetes and hypertension (n = 209)] as well as a matched sample with neither diabetes nor hypertension (n = 202). Annual medical care costs were estimated using a combination of insurance billing records, self-reported information and chart review. All cost data pertain to a 12-month period in 2001-2002. In addition to a descriptive analysis of costs across medical service categories and samples, we also conducted multivariate analyses of total cost, controlling for patient demographics, education, employment, smoking, and comorbidities, such as heart disease, hyperlipidaemia, liver disease, chronic back pain, asthma, depression, anxiety and bronchitis. RESULTS: The estimated differential in total annual medical cost (relative to the control group) was USD 2183 for diabetes only, USD 724 for hypertension only and USD 3402 for diabetes and hypertension. Alcohol use did not significantly impact medical care costs amongst individuals with diabetes and/or hypertension. CONCLUSIONS: These cost estimates can serve as an important and useful reference source for doctors, insurance companies, health maintenance organizations (HMOs) and policy makers as they try to anticipate the future medical care needs and associated costs for diabetic and hypertensive patients.

Age Factors↗
PubMed2004

Methadone: applied pharmacology and use as adjunctive treatment in chronic pain.

This article reviews the unique pharmacological properties of methadone and outlines its appropriate clinical application, with focus upon its use in the treatment of chronic pain. Although methadone is most widely known for its use in the treatment of opioid dependence, methadone also provides effective analgesia. Patients who experience inadequate pain relief or intolerable side effects with other opioids or who suffer from neuropathic pain may benefit from a transition to methadone as their analgesic agent. Adverse effects, particularly respiratory depression and death, make a fundamental knowledge of methadone's pharmacological properties essential to the provider considering methadone as analgesic therapy for a patient with chronic pain.

Analgesics, Opioid↗
PubMed2003

Development of a dual recombinant vaccine to protect small ruminants against peste-des-petits-ruminants virus and capripoxvirus infections.

A recombinant capripoxvirus vaccine containing a cDNA of the peste-des-petits-ruminants virus (PPRV) fusion protein gene was constructed. A quick and efficient method was used to select a highly purified recombinant virus clone. A trial showed that a dose of this recombinant as low as 0.1 PFU protected goats against challenge with a virulent PPRV strain.

Animal Diseases↗
PubMed2002

Goat immune response to capripox vaccine expressing the hemagglutinin protein of peste des petits ruminants.

Sheep-pox and capripox are contagious diseases of domestic small ruminants for which the causal agent is a poxvirus classified into the Capripoxvirus genus. Viruses of this group have a host range specific to sheep, goats, cattle, and possibly buffalo. Thus, they are clearly indicated as vectors for the development of recombinant vaccines for peste des petits ruminants (PPR). Here we report the immune response of goats inoculated with a recombinant capripox-PPR hemagglutinin.

Animals↗
PubMed2001

Heme-regulated eIF2alpha kinase (HRI) is required for translational regulation and survival of erythroid precursors in iron deficiency.

Although the physiological role of tissue-specific translational control of gene expression in mammals has long been suspected on the basis of biochemical studies, direct evidence has been lacking. Here, we report on the targeted disruption of the gene encoding the heme-regulated eIF2alpha kinase (HRI) in mice. We establish that HRI, which is expressed predominantly in erythroid cells, regulates the synthesis of both alpha- and beta-globins in red blood cell (RBC) precursors by inhibiting the general translation initiation factor eIF2. This inhibition occurs when the intracellular concentration of heme declines, thereby preventing the synthesis of globin peptides in excess of heme. In iron-deficient HRI(-/-) mice, globins devoid of heme aggregated within the RBC and its precursors, resulting in a hyperchromic, normocytic anemia with decreased RBC counts, compensatory erythroid hyperplasia and accelerated apoptosis in bone marrow and spleen. Thus, HRI is a physiological regulator of gene expression and cell survival in the erythroid lineage.

Animals↗
PubMed2001

The AMA Residency Training in Adolescent Preventive Services Project: report of the working group. The American Medical Association.

PURPOSE: To improve resident education in provision of adolescent preventive health care. The American Medical Association (AMA) Residency Training in Adolescent Preventive Services Project Working Group convened to identify specific goals and objectives (G&Os) for pediatric and family medicine resident education in adolescent clinical preventive services and recommend strategies to achieve these G&Os. METHODS: Iterative review process involving members of the working group, nine experienced teaching faculty and 16 resident physicians from family medicine and pediatric training programs, and an advisory board. RESULTS: We achieved consensus on appropriate G&Os for pediatric and family medicine residency education in adolescent clinical preventive services. Faculty and residents expressed concerns about achieving G&Os because of challenges to implementing effective training and evaluation strategies. Suggestions for achieving G&Os included development of an adolescent clinical preventive services curriculum and evaluation program that could be adapted for use in a variety of training program structures. Faculty and residents anticipated the success of a training curriculum would be influenced by: (a) availability of adequate numbers of skilled teaching faculty; (b) availability of time and support for faculty development and teaching efforts; and (c) exposure of residents to adequate numbers of adolescent patients in settings where there are clear expectations for delivery of comprehensive preventive services. CONCLUSIONS: The AMA Residency Training in Adolescent Preventive Services Project Working Group presents G&Os for organizing training experiences in adolescent clinical preventive services in family medicine and pediatric residency training programs and recommends strategies to achieve these G&Os.

Adolescent↗
PubMed2001

Cocaine addicts and their families. An empirical study of the processes of identification.

The processes of identification between adolescent cocaine addicts and their parents were studied in 402 subjects, in total 134 familial triads (father-mother-son), subdivided into two groups of 67 triads, one of these groups having as the child an adolescent of masculine sex dependent on cocaine and the other, equal in number, being a control group, duly matched for age and socio-economic status. The instrument employed was the Rorschach test (1922), limited to the application of the Lerner Defense Scale (LDS; Lerner & Lerner, 1980). The findings in the affected triads showed up as consistent statistically for the presence of intense processes of pathological identification, especially between father and son, a sign of the importance of the presence of disturbances of paternal function in the development of this addiction. The utilisation of very regressive defence mechanisms, above all of projective identification, was the predominant mode of procedure in triads with a dependent child. In comparisons between the fathers the odds ratio (OR) for projective identification was 8.66 to 1, which points to the association between cocaine addiction and the primitive mental functioning of the fathers. With empirical methodology these findings serve to corroborate the psychoanalytical conclusions based on studies of single case studies, testifying that the dysfunctions of identificatory phenomena in familial functioning are predominant in the mental organisation of cocaine addicts.

Adolescent↗
PubMed2001

Organized sports for children and preadolescents.

Participation in organized sports provides an opportunity for young people to increase their physical activity and develop physical and social skills. However, when the demands and expectations of organized sports exceed the maturation and readiness of the participant, the positive aspects of participation can be negated. The nature of parental or adult involvement can also influence the degree to which participation in organized sports is a positive experience for preadolescents. This updates a previous policy statement on athletics for preadolescents and incorporates guidelines for sports participation for preschool children. Recommendations are offered on how pediatricians can help determine a child's readiness to participate, how risks can be minimized, and how child-oriented goals can be maximized.

Age Factors↗
PubMed2000

Sentinel lymph node biopsy for melanoma in young children.

Lymphoscintigraphy and sentinel lymph node biopsy techniques can be applied successfully to young children with melanoma to detect nodal disease. The authors describe their methods of lymphoscintigraphy and sentinel node biopsy and its application in 2 young children with malignant melanoma of the head and neck.

Biopsy↗
PubMed2000

A national survey of training in substance use disorders in residency programs.

OBJECTIVE: To determine the amount of formal training in substance use disorders that occurs in selected residency programs and to identify the perceived barriers to such training. METHOD: A national survey was conducted of program directors in emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics and psychiatry. In 1997, program directors were mailed a brief survey to determine the extent to which required training in substance use disorders occurred and the median number of hours devoted to substance use disorders training. Follow-up telephone surveys were conducted with faculty designated in the survey as responsible for substance-related disorders training to determine type of training and barriers to training. RESULTS: Of 1,831 program directors, 1,183 (64.6%) responded to the brief survey. The percentage of programs with required substance use disorders training ranged from 31.8% in pediatrics to 95.0% in psychiatry, with 56.3% for all programs combined. The median number of curricular hours ranged from 3 (emergency medicine and OB/GYN) to 12 (family medicine). Time was perceived to be the most common barrier to additional training. CONCLUSIONS: Consistent training for all residents in the initial diagnosis and management of substance use disorders has not been achieved. New strategies that integrate into existing residency structures are needed to improve substance use disorders training. Faculty development in substance use disorders and review of current substance use disorders training as part of the residency review process should facilitate this endeavor.

Alcoholism↗
PubMed2000

AutoCyte Prep system vs. conventional cervical cytology. Comparison based on 2,156 cases.

OBJECTIVE: To compare the AutoCyte Prep system (Burlington, North Carolina) with conventional cervical cytology in a university medical center laboratory. STUDY DESIGN: Split-sample conventional and AutoCyte Preps were examined for 2,156 cases. Same-patient conventional and Prep slides were submitted to separate cytotechnologists blindly. The results were compared on review by a cytopathologist. The Prep slides were subsequently scanned on the AutoCyte Screen automated interactive system, with manual review of the flagged cases. The results were compared with anatomic pathology follow-up when available. RESULTS: Of the 158 squamous intraepithelial lesions (SILs) found by both methods, 78% were found by AutoCyte Prep, while 59% were found by conventional smear (P < .01). Among the discordant cases, thin-layer slides revealed 88% more LSIL lesions (P < .05), a comparable number of high grade SIL lesions and a single case of adenocarcinoma that was ambiguous on the conventional slide. The addition of AutoCyte assisted primary screening demonstrated a net benefit, recovering additional cases referenced as atypical glandular cells of undetermined significance and as high grade SIL. CONCLUSION: The AutoCyte Prep system affords excellent cellular presentations and superior sensitivity for SILs when compared to the conventional technique. The use of AutoCyte Screen, for primary screening demonstrated performance equivalent to manual screening, with a significant improvement in sensitivity when measured against biopsy results.

Adenocarcinoma↗
PubMed1999

Brief intervention in primary care settings. A primary treatment method for at-risk, problem, and dependent drinkers.

Primary health care providers identify and treat many patients who are at risk for or are already experiencing alcohol-related problems. Brief interventions--counseling delivered by primary care providers in the context of several standard office visits--can be a successful treatment approach for many of these patients. Numerous trials involving a variety of patient populations have indicated that brief interventions can reduce patients' drinking levels, regardless of the patients' ages and gender. In clinical practice, brief interventions can help reduce the drinking levels of nondependent drinkers who drink more than the recommended limits, facilitate therapy and abstinence in patients receiving pharmacotherapy, and enhance the effectiveness of assessment and treatment referral in patients who do not respond to brief interventions alone. Despite the evidence for their usefulness, however, brief interventions for alcohol-related problems have not yet been widely implemented in primary care settings.

Alcohol Drinking↗
PubMed1998

Serological evidence of morbillivirus infection in small cetaceans from the Southeast Pacific.

The presence of morbillivirus-specific serum antibodies was examined by an indirect enzyme linked immunosorbent assay (iELISA) and virus neutralization tests in serum samples from 30 dusky dolphins (Lagenorhynchus obscurus), 8 long-snouted common dolphins (Delphinus capensis), 2 inshore and 6 offshore bottlenose dolphins (Tursiops truncatus) and 20 Burmeister's porpoises (Phocoena spinipinnis) taken in fisheries off central Peru in 1993-1995. The sera from six dusky dolphins, one common dolphin and three offshore bottlenose dolphins were positive on a coat of dolphin morbillivirus (DMV) antigen in the iELISA. Several of these sera were also positive when tested against peste des petits ruminants and rinderpest virus antigen. Porpoise morbillivirus and/or DMV neutralizing antibodies were detected in the sera of two bottlenose and three dusky dolphins that reacted positively with DMV antigen in iELISA and also in the sera of one common, one dusky and one bottlenose dolphin that were negative in the iELISA. These results strongly suggest that viruses closely related, or identical, to the cetacean morbillivirus present in the North Atlantic and the Mediterranean Sea infect several species of Delphinidae of the Southeastern Pacific. No convincing morbillivirus-specific antibody positive reactions were detected in the sera from either the Burmeister's porpoises or the inshore bottlenose dolphins.

Animals↗
PubMed1998

Adenocarcinoma simulating mesothelioma: a clinicopathologic and immunohistochemical study of 29 cases.

We report 29 cases of adenocarcinomas whose clinical, gross, and microscopic appearance resembled diffuse malignant pleural mesothelioma. Initial criteria for inclusion in the study included availability of an open pleural biopsy or decortication specimen and microscopic evidence of neutral (periodic acid-Schiff positive) mucin in the tumor. The median age of the patients was 63 years (range, 31 to 78 years), with a peak age in the seventh decade. There were 24 men and five women. Thirteen of them had a history of smoking; six (21%) had possible or definite occupational exposure to asbestos. Three (21%) of 14 lung specimens showed ferruginous bodies and two (14%) showed microscopic evidence of asbestosis. At least 25 patients had pleural effusion, most typically unilateral. Needle biopsy of pleura showed malignancy in 10 (77%) of 13 cases. Most (20 of 29) patients underwent pleural stripping. Radiotherapy and chemotherapy was each given to three patients without effect. Median survival by Kaplan-Meier estimate was 8 months, with an 18-month survival of 13%. Histologically, glands (23 cases), nests (13 cases), tubulopapillary arrays (12 cases), or sheets (eight cases) of tumor cells were found. Spindling of neoplastic cells was seen in 10% of cases. Three (21%) of 14 lung specimens showed a subpleural adenocarcinoma. Antibodies to polyclonal CEA, Ber-EP4, Leu-M1, and B72.3 were positive in 94%, 56%, 50%, and 44% of cases, respectively. All but one of the cases stained with two or more of the antibodies CEA, Ber-EP4, Leu-M1, or B72.3. This study indicates that adenocarcinomas simulating mesothelioma are aggressive variants of peripheral adenocarcinomas with a poor prognosis, that they can show pathological evidence of asbestos exposure in a subset of cases, and that immunohistochemical and histochemical stains are useful in their differential diagnosis with diffuse malignant mesotheliomas.

Adenocarcinoma↗
PubMed1998

The effects of visual distraction following traumatic brain injury.

Clinical assessments of individuals with traumatic brain injury (TBI) typically report attentional difficulties, with distractibility prominent among these complaints. However, laboratory-based measures have often failed to find disproportionate distraction among patients with TBI, as compared to control participants. In this experiment, we tested 21 patients hospitalized for rehabilitation following recent TBI and 21 demographically comparable control subjects on a visual reaction time go-no-go task in which the target was preceded or followed by a brightly colored moving visual stimulus, appearing above the target location. Early distractors actually served as warning stimuli, improving accuracy and speed for both participant groups. Distractors occurring at or shortly after the time of target presentation had no significant impact on accuracy or response bias in either group, but did produce slowing of RT that was significantly greater for patients than for controls. The distractor that produced maximal slowing occurred 100 ms after the presentation of the target or foil. Repeated testing sessions led to reduction in the impact of the distractor and loss of the group difference in RT impact. The degree of RT slowing induced by distraction was modestly related to injury severity, as measured by the current score on the Disability Rating Scale, and the time until the patient first followed verbal commands. There was also a trend of greater RT slowing among individuals with focal orbitofrontal lesions, as assessed on neuroimaging studies. These results document a greater susceptibility to extraneous visual distraction among patients with TBI in comparison to controls. The fact that this difference appears only in the RT domain, and is greatest when the distractor follows the target, suggests that the primary impact of visual distractors is on response preparation and execution rather than target detection.

Adolescent↗